ObjectiveTo investigate the effect of breast conservation therapy (BCT) and mastectomy (Mast) on the prognosis of early luminal breast cancer (ELBC).MethodsBy retrieving the PubMed, Embase, Web of Science, CNKI, Wanfang data, and VIP databases, the meta-analysis was performed on the documents that met the inclusion criteria. The Review Manager 5.3 and Stata 12.0 were used for statistical analysis.ResultsA total of 25 articles were included, involving 13 032 patients with ELBC, of which 8 419 underwent the BCT and 4 613 underwent the Mast. The results of meta-analysis showed that there was no significant difference in the postoperative local regional relapse (LRR) between the BCT and the Mast in the treatment of all patients with ELBC [OR=0.84, 95% CI (0.43, 1.64), P=0.61]. For treating with BCT, the local relapse (LR), distant metastasis rate (DMR), disease-free survival (DFS), and overall survival (OS) in the patients with luminal A ELBC were better than those in the patients with luminal B ELBC (P<0.05); Using the same method, the DMR and DFS in the patients with luminal A/B ELBC were better than those in the patients with luminal-HER2 ELBC (P<0.05). For treating with Mast, the LRR, LR, DMR, and OS in the patients with luminal A ELBC were better than those in the patients with luminal B ELBC (P<0.05); Using the same method, the LRR in the patients with luminal A/B ELBC was better than that in the patients with luminal-HER2 ELBC (P<0.05).ConclusionsFor patients with ELBC, similar LRR can be obtained by BCT and Mast treatment. Regardless of the surgical strategy, patients with luminal A ELBC are more likely to obtain relatively ideal clinical prognosis. Luminal-HER2 ELBC has the worst prognosis after BCT treatment.
ObjectiveTo investigate the factors influencing pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) in patients with luminal breast cancer (LBC), and to construct and validate a nomogram-based predictive model. MethodsPatients with LBC who received NACT at the Affiliated Hospital of Southwest Medical University between January 2021 and February 2025 were retrospectively enrolled. Patients were randomly divided into training cohort (n=205) and validation cohort (n=87) by a ratio of 7∶3. Multivariate logistic regression analyses was performed in the training cohort, and a nomogram was developed based on the multivariate results. Model discrimination was evaluated using receiver operating characteristic (ROC) curves, calibration was assessed using calibration plots, and clinical utility was examined using decision curve analysis (DCA) in both cohorts. ResultsMultivariate logistic regression analysis in the training cohort showed that clinical tumor stage 4 [OR=0.018, 95%CI (0.001, 0.312), P=0.006], estrogen receptor expression>37.5% [OR=0.275, 95%CI (0.095, 0.798), P=0.018], and Ki-67 index>47.5% [OR=4.134, 95%CI (1.480, 11.544), P=0.007] were independent factors associated with pCR after NACT in LBC patients. A nomogram was constructed accordingly. The area under the ROC curve of the predictive model was 0.834 in the training cohort and 0.785 in the validation cohort. Calibration curves and Hosmer-Lemeshow tests demonstrated good predictive performance of the model in both cohorts (χ2=1.610, P=0.807; χ2=1.859, P=0.762). DCA indicated that the nomogram provided the greatest net benefit when the threshold probability ranged from 0% to 50% in both cohorts. ConclusionsClinical tumor stage, estrogen receptor expression level, and Ki-67 index were independent predictors of pCR after NACT in LBC patients. The nomogram constructed based on these factors showed good predictive performance in both the training and validation cohorts.
ObjectiveTo compare the prognosis of neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) in patients with T1-2N1-2M0 luminal breast cancer, and to analyze the factors affecting the prognosis. MethodsPatients with luminal breast cancer who met the inclusion criteria and had complete follow-up data from January 2014 to December 2019 were retrospectively collected. Patients received either neoadjuvant chemotherapy (NAC) or adjuvant chemotherapy (AC), both based on anthracycline-containing regimens. Kaplan-Meier analysis was performed to estimate survival, and Cox proportional hazards regression was used to identify risk factors affecting 5-year cumulative overall survival rate. The significance level was set at α=0.05. ResultsA total of 206 patients (99 receiving NAC and 107 receiving AC) who met the inclusion criteria were enrolled. The cohort comprised 101 patients with luminal A (57 AC, 44 NAC) and 105 with luminal B (50 AC, 55 NAC). At a median follow-up of 72.5 months, no significant difference in the 5-year cumulative overall survival rate was observed between AC and NAC patients (89.7% vs. 88.9%, P=0.571); However, the 5-year cumulative disease-free survival rate was significantly higher in the AC group as compared with the NAC group (85.0% vs. 73.5%, P<0.001). Subgroup analysis demonstrated that no significant differences in the 5-year cumulative overall survival rates between AC and NAC patients within either luminal A (94.7% vs. 86.4%, P=0.727) or luminal B (84.0% vs. 89.3%, P=0.864). However, for patients with luminal A, the 5-year cumulative disease-free survival rate was significantly higher in the AC subgroup than in the NAC subgroup (93.0% vs. 77.3%, P<0.001). In contrast, no significant difference in the 5-year cumulative disease-free survival rate between AC and NAC patients was observed in patients with luminal B (74.0% vs. 71.4%, P=0.201). Multivariate analysis using the Cox proportional hazards model identified the following independent risk factors for lower 5-year cumulative overall survival rate in patients with T1-2N1-2M0 luminal breast cancer: N2 stage [HR (95%CI)=2.290 (1.249, 4.196)], lymphovascular invasion [HR (95%CI)=2.181 (1.182, 4.026)], omission of endocrine therapy [HR (95%CI)=6.013 (2.590, 13.965)], and absence of pathological complete response after NAC [HR (95%CI)=2.403 (1.284, 4.496)]. ConclusionsThe results of this study suggest that patients with T1-2N1-2M0 luminal breast cancer can achieve higher disease-free survival from AC. But it is still necessary to comprehensively consider the patient’s condition such as lymph node metastasis, vascular cancer thrombus to formulate an individualized treatment plan to increase the overall survival rate of patients.